Doctor Name: | SHAHRAD RADI SHAMSI |
NPI Number: | 1700944378 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A68990 |
Business Practice Address: | 2021 Santa Monica Blvd Ste 325e Santa Monica, CA - 904042149 |
Business Phone Number: | 3104530504 |
Business Fax Number: | 3104530520 |
Mailing Address: | 2021 Santa Monica Blvd Ste 325e, SANTA MONICA |
State: | CA |
Postal Code: | 904042149 |
Phone Number: | 3104530504 |
Fax Number: | 3104530520 |
NPI Enumeration Date: | 12/05/2006 |
NPI Last Update Date: | 11/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | A68990 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |